Endocarditis in Adults with Bacterial Meningitis
Background—Endocarditis may precede or complicate bacterial meningitis, but the incidence and impact of endocarditis in bacterial meningitis is unknown.
Methods and Results—We assessed the incidence and clinical characteristics of patients with meningitis and endocarditis from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands performed from 2006 to 2012. Endocarditis was identified in 24 of 1025 (2%) episodes of bacterial meningitis. Cultures yielded Streptococcus pneumoniae in 13 patients, Staphylococcus aureus in 8 patients, and Streptococcus agalactiae, Streptococcus pyogenes and Streptococcus salivarius each in 1 patient. Clues leading to the diagnosis of endocarditis were cardiac murmurs, persistent or recurrent fever, a history of heart valve disease and S. aureus as causative pathogen of bacterial meningitis. Treatment consisted of prolonged antibiotic therapy in all patients and surgical valve replacement in 10 patients (42%). Two patients were treated with oral anticoagulants and both developed life-threatening intracerebral hemorrhage. Systemic (70%) and neurologic complications (54%) occurred frequently, leading to a high proportion of patients with unfavorable outcome (63%). Seven of 24 patients (29%) with meningitis and endocarditis died.
Conclusions—Endocarditis is an uncommon co-existing condition in bacterial meningitis, but is associated with a high rate of unfavorable outcome.
- Received January 24, 2013.
- Revision received April 3, 2013.
- Accepted April 10, 2013.